1. Cranberry Juice & Bladder Infections Kristen Siu & Divya Unni NST 192

2. Overview I.Urinary tract infections II.Cranberry juice as a solution III.Supporting Studies IV.Opposing Studies V.Improvements VI.Conclusion

3. Urinary tract infections Urinary Tract Infections (UTI) o E. Coli infect and colonize the urinary tract Symptoms o burning pain when urinate o cloudy urine o fever and chills Women are more affected o shorter urethra

4. Cranberry juice as a solution ●Native Americans first recognized benefits ●Contains fructose and A-type proanthocyanidins inhibit E.Coli adherence

5. Supporting Argument #1 ●Study of 28 women with recurrent UTIs ●Divided into 5 groups and given different amounts ●Compared to baseline before intervention ●91 percent free of UTIs for three months

6. Supporting Argument #2 ●150 adult women divided into three groups ○ cranberry juice, lactobacillus, nothing ●After 6 months', 16% of the cranberry group, 39% of the lactobacillus group, and 36% of the control group experienced 1 recurrence of UTIs

8. Opposing Argument #1 176 premenopausal women (18-45 yo) with a history of recent UTI randomized to 1 of 3 arms for a 6 month trial o 4 oz cranberry juice, 8 oz cranberry juice, placebo juice Time to UTI (symptoms + pyuria) was main outcome Conclusion: no significant reduction in UTI risk compared to placebo group

10. Opposing Argument #2 2012 Systematic review from Cochrane Database looking at 24 RCT studies (4473 participants) Want to assess the effectiveness of cranberry products in preventing UTIs in susceptible populations Conclusion: current review suggest cranberry juice is less effective than previously indicated

11. Improvements Alternatives to cranberry juice o Tablets, powders, capsules Aim for double-blinded, randomized control trial Choose a diverse range of participants or narrow to high risk population Choose a suitable length of study depending on cranberry product used in trial

12. Conclusions Still a controversy o In vitro lab studies have shown positive results for effects of cranberry juice on bacteria that cause UTIs o Human studies do not have statistically significant data to back in vitro studies Future research still needed to determine the true efficacy of cranberry juice on UTIs

13. Sources 1) Stapleton A.E., Dziura J, Hooton T.M., Cox M.E., Yarova-Yarovaya Y, Chen S, Gupta K. Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: a randomized controlled trial. Mayo Clin Proc. 2012; 87 (2): 143-150. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3497550/pdf/main.pdf. Accessed October 13, 2013 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3497550/pdf/main.pdf 2) Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD001321. DOI: 10.1002/14651858.CD001321.pub5. 3) Kontiokari T. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in. BMJ. 2001;322(7302):1571-1571. 4) Wang, P.The Effectiveness of Cranberry Products to Reduce Urinary Tract Infections in Females. Urol Nurs. 2013;33(1):38-45.